PRE-CLINICAL PEDIATRIC DENTISTRY - …pre-clinical pediatric dentistry ... ch.21, pg. 341)...

PRE-CLINICAL PEDIATRIC DENTISTRY DSV 342

Restorative Dentistry for the primary Dentition (Pinkham, Ch.21, Pg. 341)

RESTORATION OF PRIMARY MOLARS

5 update 23/2/2012

Professor Othman Al-Ajlouni Salman Bin Abdul Aziz University18-Dec-11111-Nov-14

Tuesday 28/2/2012 9:00 -10:00 am

Tuesday, November 11, 2014 1 Professor Othman Al-Ajlouni

RESTORATIVE DENTISTRY FOR THE PRIMARY DENTITION

OBJECTIVES

• Repair or limit the damage of dental caries

• Protect and preserve remaining the pulp and remaining tooth structure

• Ensure adequate function

• Restore aesthetics (where applicable)

• Provide ease in maintaining good oral hygiene

• Retained natural spaces for the developing permanent dentition



• INSTRUMENTATION • ANATOMIC CONSIDERARTIONS OF PRIMARY TEETH • USE OF THE RUBBER DAM IN PEDIATRIC RESTORATIVE DENTISTRY • RESTORATION OF PRIMARY MOLARS CLASS I AMALGAM RESTORATIONS CLASS II AMALGAM RESTORATIONS ADHESIVE MATERIALS IN PRIMARY MOLARS USE OF STAINLESS STEEL CROWNS • RESTORATION OF PRIMARY INCISORS AND CANINES CLASS III ADHESIVE RESTORATIONS CLASS V RESTORATIONS FOR INCISORS AND CANINES FULL CORONAL COVERAGE OF INCISORS • PROSHETIC REPLACEMENT OF PRIMARY ANTERIOR TEETH



• RESTORATION OF PRIMARY MOLARS

CLASS I AMALGAM RESTORATIONS

CLASS II AMALGAM RESTORATIONS

ADHESIVE MATERIALS IN PRIMARY MOLARS

USE OF STAINLESS STEEL CROWNS

• RESTORATION OF PRIMARY INCISORS AND CANINES

CLASS III ADHESIVE RESTORATIONS

CLASS V RESTORATIONS FOR INCISORS AND CANINES

FULL CORONAL COVERAGE OF INCISORS

• PROSHETIC REPLACEMENT OF PRIMARY ANTERIOR TEETH



• Inexpensive

• Ease of use

• Proven track record

– >100 years

• Familiarity

• Resin-free

• Moisture forgiving

• No polymerization shrinkage

• less allergies than Composite

• Excellent mechanical properties


• Not adhesive

• Requires mechanical retention

• Environmental and

occupational hazards

• Public concerns

• Not esthetic


GENERAL CONSIDERATIONS • OUTLINE FORM: include all retentive Fs and carious areas as conservative as

possible, smoothly flowing arcs and curves, and slightly rounded all internal angles.



GENERAL CONSIDERATIONS


• PULPAL FLOOR: 0.5 mm depth into dentin (approximately 1.5 mm

from enamel surface)





• BUCCAL DEVELPOMENTAL PITS: 75&85 restored with small teardrop or ovoid-

shaped including all adjacent susceptible Ps&Fs OR fissure sealed

• DENTAL BUR: cutting end is 1.5 mm length no.330



• CAVOSURFACE MARGIN: no bevel and placed out of stress-bearing

areas

• DOVETAIL: 75&85 buccolingual width>isthmus width

• ISTHMUS: 1/3 intercuspal width and buccolingual walls converge occlusally slightly

• MESIAL&DISTAL WALL: flare at the marginal ridge

• OBLIQUE RIDGES: not be crossed except when undermined with caries or deep fissure

Tuesday, November 11, 2014 Professor Othman Al-Ajlouni 10





• BUCCAL DEVELPOMENTAL PITS: 75&85 restored with small teardrop or ovoid-

shaped including all adjacent susceptible Ps&Fs OR fissure sealed

• DENTAL BUR: cutting end is 1.5 mm length no.330



• CAVOSURFACE MARGIN: no bevel and placed out of stress-bearing

areas

• DOVETAIL: 75&85 buccolingual width>isthmus width

• ISTHMUS: 1/3 intercuspal width and buccolingual walls converge occlusally slightly

• MESIAL&DISTAL WALL: flare at the marginal ridge

• OBLIQUE RIDGES: not be crossed except when undermined with caries or deep fissure

Burnishing

• Pre-carve

– removes excess mercury

– improves margin adaptation

• Post-carve

– improves smoothness

• Combined

– less leakage

Early Finishing

• After initial set

– prophy cup with pumice

– provides initial smoothness to restorations

– recommended for spherical amalgams

Polishing

• Increased smoothness

• Decreased plaque retention

• Decreased corrosion

• Clinically effective?

– no improvement in marginal integrity


COMMON ERRORS

1. TOO DEEP CAVITY

2. UNDERCUTTING THE MARGINAL RIDGE

3. TOO DEEP CARVING THE ANATOMY

4. RETMAINED AMALGAM FLASH IN THE CAVOSURFACE MARGINS

5. UNDERCARVING

6. NOT INCLUDING SUSCEBTIBLE FISSURES



GENERAL CONSIDERATIONS FOLLOW THE GUIDELINES FOR CLASS I IN THE OCCLUSAL PORTION

PROXIMAL BOX • broader at the cervical portion>occlusal portion

• break contact area allow tip of an explorer to pass buccally, lingually and gingivally

• Buccal & Lingual walls create a 90-degree angle with enamel

• Flat gingival wall, not beveled, remove unsupported enamel

• Axial wall into dentin for 0.5 mm and follow same contour of the outer proximal contour

• Axiopulpal line angle is beveled or rounded

• Mesiodistal width of gingival seat is 1 mm = no. 330 bur width



Proximal walls are convergent

occlusally,

portions of the prep extend

into buccal and lingual

grooves,

pulpal floor is flat and uniform

depth, gingival floor is 1 – 1.5

mm wide mesiodistally.

Acceptable


Assuming a small interproximal lesion, just inside the DEJ. The size and axial depth of the box would rate this Improvable. If there was a pulpal exposure, it would be Unacceptable


MATRIX APPLICATION

Aid in restoring normal contour

Aid in restoring normal contact areas

Prevent extrusion of filling into gingival tissues



MATRIX APPLICATION

TYPES 1. T-BAND

2. SECTIONAL MATRIX

3. AUTOMATRIX

4. SOPT-WELDED MATRIX

5. TOFFLEMIRE MATRIX



MATRIX APPLICATION

TYPES 1. T-BAND: allows for multiple matrices, no special equipment is needed.

Different sizes, contours, and materials. Straight, narrow, brass T band.

Formed into a circle, and the extensions wings are folded down to secure the band to make an adjustable loop. The T-band is adapted to fit the tooth tightly and is trimmed with scissors, and the free end is bent back. The free end is drawn mesially to pull the band snugly against the tooth. The extension folds are then grasped firmly wit a pair of Howe no. 110 pliers and removed from the tooth. The band tightened an additional 0.5 to 1.0 mm, and free end bent back over the vertical folds and cut with scissors to length of 5 to 6 mm. then band reseated onto the tooth and wedged, fit below gingival margin and 1 mm higher than marginal ridge of adjacent tooth.



MATRIX APPLICATION

TYPES 1. T-BAND

2. SECTIONAL MATRIX OR MATRIX PIECES (STRPI-T): SS matrix strips ½ inch long fit the prepared proximal area.

Not indicated for proximal preparations that extend beyond the line angles; a circumferential matrix or SSC more appropriate.



MATRIX APPLICATION

TYPES 1. T-BAND

2. SECTIONAL MATRIX

3. AUTOMATRIX:

Preformed loop of SS matrix and tightened with a special tightening tool.

A small pin automatically keeps the tightened matrix tightly bound around the tooth.

To remove it, the pin is clipped with a special tool and the matrix is easily loosened and removed.



MATRIX APPLICATION

TYPES 1. T-BAND

2. SECTIONAL MATRIX

3. AUTOMATRIX

4. SOPT-WELDED MATRIX:

A piece of matrix band 2 inches in length is cut from the spool and the ends are welded together in one spot to form a loop. This loop is placed around the tooth and adapted snugly by grasping the band with Howe no. 110 pliers from the buccal surface. The band is removed, and two spot welds are placed at the seam where band was pinched together on buccal surface. Excess band is cut away with scissors. Contouring pliers used to contour cervical and contact areas.



• RESTORATION OF PRIMARY MOLARS




USE OF STAINLESS STEEL CROWNS

• RESTORATION OF PRIMARY INCISORS AND CANINES

CLASS III ADHESIVE RESTORATIONS

CLASS V RESTORATIONS FOR INCISORS AND CANINES

FULL CORONAL COVERAGE OF INCISORS

• PROSHETIC REPLACEMENT OF PRIMARY ANTERIOR TEETH



TYPES

1. Resin-based composites

2. Polyacid-modified resin-based composites (compomers)

3. Resin-modified glass ionomers (Vitremere,3M ESPE, St. Paul, Minn.)

4. Glass ionomers



ADVANTAGES

1. Improved aesthetics

2. Elimination of mercury

3. Low thermal conductivity

4. More conservation of tooth structure

5. Bonding to the tooth



DISADVANTAGES

1. Exacting technique

2. Increased operator time

3. Potential marginal leakage

4. Possible postoperative sensitivity

5. Tendency to open or lose contacts



General principles with resin-based composite

1. Highly Technique sensitive

2. Depends on case selection in overall clinical performance

3. Depends on a skilled operator

4. Proper application requires knowledge of adhesives, composites, polymerization kinetics and the ability to apply those principles

5. Unforgiving materials

6. GICs not indicated for multisurface or large restorations in primary molars



General principles with resin-based composite

1. Highly Technique sensitive: affected negatively by any moisture contamination

2. More conservative preparations: do not require volume to resist clinical fracture, allowing for smaller, shallower preparation. No need fro extension fro prevention, instead sealant used for noncarious Ps&Fs

3. Bond to tooth structure, minor need for retention preparation

4. Wear most common problem with posterior resin-based composites: minimized by small preparation and out of heavy occlusion



CLASS I AND CLASS II PREPARATION AND RESTORATION

1. Absolute moisture control using rubber dam

2. Slot preparation: proximal box extending line angles in self-cleaning areas, short bevel to cavosurface margin to Increase surface area for bonding and to Remove aprismatic layer

3. Prewedging: to achieve slight separation of teeth and tighter contact, the wedge protect the interproximal gingival tissue

4. Dentin bonding agent or GIC liner placed before placement of a matrix band and the adhesive material

5. Clear plastic or thin steel matrices may be used

6. Circumferential bands are contraindicated

7. 2-mm depth of composite (increment) to ensure full polymerization and reduce polymerization shrinkage.



CLASS I AND CLASS II PREPARATION AND RESTORATION

8. Finishing immediately following polymerization, the occlusal surface is grossly contoured with round, high-speed carbide finishing burs or fine-finishing diamond burs. Gross contouring proximal surface with flame-shaped, high-speed carbide finishing burs and with garnet disks. Final finishing with white stone or with rubber abrasive points and polishing with a composite polish or gloss. Fine abrasive disks or strips are used for final polishing of accessible proximal margins. Application of a surface sealant after polishing may reduce occlusal wear and contraction gaps.


In summary….

“ Primary teeth are a temporary dentition with known life expectancies of each tooth. By matching the ‘right’ restoration with the expected lifespan of the tooth, we can succeed in providing a ‘permanent’ restoration that will never have to be replaced.”

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